Chronic renal failure

Introduction:

Study carried out in 2014 showing increase in patients for years in Oshakati Hospital.

268/2014

200/2013

100/2012

CRF

TABLE NO.2 GENERAL CLINICAL CHARACTERISTICSAño 2014

Suggestions

• High mortality was found associated with late referral of patients , They were referred to nephrology belatedly.

• Strict control of patients CRF in the Local Areas.

• Monitoring by CDC doctors and Specialists in internal medicine to patients suffering from HIV positive+ CKD.

Objective

• At the end of this session , all participants should be able to:

• Define Chronic Renal Failure.• Mention the main causes of Chronic Renal

Failure.• Know the signs and symptoms of renal failure.• Know the treatment options of CRF• Know new definition of CKD

• The kidneys are a pair of brownish-red structures located retroperitoneally (behind and outside of peritoneal cavity) on the posterior wall of the abdomen from the 12th thoracic vertebra to the 3rd lumbar vertebra in the adult.

• They are measure :

-12 cm long

- 6 cm wide

- 3 cm thick

View of a sagittal section can be seen

The Kidneys Function

Blood Pressure Regulation

4 mechanisms are involved– Volume control– Aldosterone effect– Renin-angiotensin-aldosterone– Renal prostaglandin

Erythropoietin

• Erythropoietin is produced and released by the kidneys in response to decreased oxygen tension in the renal blood supply that is created by the loss of red blood cells.

• Erythropoietin stimulates the production of RBCs in the bone marrow.

• Erythropoietin deficiency leads to anemia in renal failure.

Fluids regulation

Output(0,9+1,5+0,1= 2,5)

Diagnostic Tools for Assessing Renal Failure

• Blood Tests– BUN elevated (norm 10-20)– Creatinine elevated (norm 85 - 132)– K elevated

– PO4 elevated

– Ca decreased• Urinalysis– Specific gravity– Protein– Creatinine clearance (GFR)

Diagnostic Tools

• Biopsy• X-Rays• Ultrasound:

-Finding of small echogenic kidneys

b/l (<10 cm) by US supports dx of CKD/

Glomerular Filtration RateGFR

• 24 hour urine for creatinine clearance

• Can estimate creatinine clearance by:

(140 – age) x weight (kg)}

72 x serum creatinine

Actually already since 2004, the international community began

using the term of CKD for replacing the term of CRF

NKF Classification System*

Chronic Kidney Desease (CKD).

* Kidney International (2004) 67, 2089–2100;

Prevalence of CKD . General Populacion .Oshakati. Namibia. 36,000/2015

Stage Descrpition GRF Population36,000

% Prevalence

1 Kidney Damage wiht normal ↑ GRF

CKD > 90 ml/min 1,188 3,3

2 Kidney Damage wiht Mild GFR

CKD 60 – 89 ml/min 1,080 3

3 Moderate ↓ GRF CKD 30 – 59ml/min 1,548 4,3

4 Severe ↓ GRF CKD 15 – 29 ml/min 72 0,2

5 Kidney Failure CKD < 15 ml/min 36 0,1

Causes of Chronic Kidney Disease

• Hypertension• Diabetes• Glomerulonephritis• Cystic disorders• Developmental -

Congenital• Infectious (HIV)sea

• Neoplasms• Obstructive disorders• Autoimmune diseases– Lupus

• Hepatorenal failure• Scleroderma• Amyloidosis• Drug toxicity

What happens when the kidneys don’t function Properly??

Manifestations of CRF

Skin• Pale, grayish-bronze

color• Dry scaly• Severe itching• Bruise easily• Uremic frost

Central Nervous Systems

• Include irritability, difficulty concentrating, insomnia.

• Confused sates

Manifestations of CRF

Fluid - Electrolyte - pH• Volume expansion

and fluid overload• Metabolic Acidosis• Electrolyte

Imbalances–Hyperkalemia

GI Tract• Uremic fetor• Anorexia, nausea,

vomiting• GI bleeding

Manifestations of CRF

Hematologic• Anemia• Platelet dysfunction

Musculoskeletal• Muscle cramps• Soft tissue

calcifications• Weakness• Related to calcium

phosphorous imbalances

Manifestations of CRF

Endocrine - Metabolic

• Erythropoietin production decreased

• Hypothyroidism• Insulin resistance• Growth hormone decreased• Gonadal dysfunction• Parathyroid hormone and

Vitamin D3

• Hyperlipidemia

Heart - Lungs

• Hypertension• Congestive heart failure• Pericarditis• Pulmonary edema• Pleural effusions

FAST FOOD

How To Avoid Kidney Disease\FailureTHE FOLLOWING COULD CAUSE KIDNEY DISEASE:

• Delaying going to a toilet Keeping your urine in your bladder for too long is a bad idea.

• A full bladder can cause bladder damage. The urine that stays in the bladder multiplies bacteria quickly.

Eating too much saltYou should eat no more than 5.8 grams of salt daily

Eating too much meat. Too much protein in your diet is harmful for your kidneys. Protein digestion produces ammonia

Not drinking water. Our kidneys should be hydrated properly to perform their functions well. If we don't drink enough, the toxins can start accumulating in the blood, as there isn't enough fluid to drain them through the kidneys.

Lack of Medical Checks . Treat all your health problems properly and have your health checked regularly.

Stop Smoking and Stop drinking alcohol. You can reduce the strain on your kidneys by cutting all alcoholic drinks out of your lifestyle. These drinks require that your kidneys work very hard and not drinking them can help prevent kidney problems.

Avoid potential medications that can hurt the kidneys

• High doses or chronic uses of antiinflammatory medications like Ibuprofen (Advil, Motrin), Naproxen (Eleve), Aspirin, indomathacin,

• Antibiotics e.g. gentamicin, Amikacin,

Estreptomicin

Adolescent Health Education Programs

CHRONIC RENAL FAILURE (ESRD)

Hemodialysis(Standard Therapy 4 hours duration/3 times /wk)

The treatment room

KIDNEY THERAPYPERITONEAL DALISIS

KIDNEY TRANSPLANTATION

Conservative management in ERSD• Conservative treatment or palliative care is an

option for patients with CKD in ESRD , but besides the CRF have other conditions or failure organs , that preclude their recovery, such as:

• Heart disease• Liver Disease• Malignancies• Advanced age

Nephrology 18 (2013) 393–400

Conservative Management• Some people decide to have ‘conservative’

treatment (also called, palliative or supportive care) rather than have dialysis or a transplant.

• The aim of conservative treatment is to manage the symptoms of kidney failure without using dialysis or transplantation.

• Conservative treatment includes medical, emotional, social, spiritual and practical care for both the person with kidney failure and their family.

Conclusion• Multiple risk-factor intervention strategy is

the best to adopt in patients with CKD• Control of BP is of paramount importance in

slowing down the progression of CKD• Control of BP is more important in slowing

the progression of CKD than control of blood sugar in patients with type II diabetes and proteinuria

• In patients with CKD, AII blockers give benefit beyond BP control

Suggestions

• The country needs of a National Prevention Program of CKD .

Prevent*Detect Treat

*Despite a lot of advancement in the fields of Medicine ,still there is not

Permanent cure for Kidney Failure.

The Governments can not support Dialysis Therapy without National Prevention Program of CKD and a program of Kidney Transplantation.

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